| NPI | 1326631508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00823500) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: GA CHIR010426) |
| Enumeration Date | 2021-02-18 |
| Last Update Date | 2026-10-16 |